Individual
NICOLE LYNNE SORDELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
875 PERIMETER DR # MS 2401, MOSCOW, ID 83844-9803
(209) 401-7964
Mailing address
5690 CALIFORNIA AVE, TRACY, CA 95304-9414
(209) 401-7964
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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